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officer\u003C\/span\u003E\u003Ca id=\u0022xref-aff-7-1\u0022 class=\u0022xref-aff\u0022 href=\u0022#aff-7\u0022\u003E7\u003C\/a\u003E, \u003C\/li\u003E\u003Cli class=\u0022contributor\u0022 id=\u0022contrib-5\u0022\u003E\u003Cspan class=\u0022name\u0022\u003EMar\u00eda Dolores Panadero\u003C\/span\u003E\u003Cspan class=\u0022contrib-role\u0022\u003E, pharmacologist\u003C\/span\u003E\u003Ca id=\u0022xref-aff-2-2\u0022 class=\u0022xref-aff\u0022 href=\u0022#aff-2\u0022\u003E2\u003C\/a\u003E, \u003C\/li\u003E\u003Cli class=\u0022contributor\u0022 id=\u0022contrib-6\u0022\u003E\u003Cspan class=\u0022name\u0022\u003EJos\u00e9 Mar\u00eda Le\u00f3n\u003C\/span\u003E\u003Cspan class=\u0022contrib-role\u0022\u003E, professor\u003C\/span\u003E\u003Ca id=\u0022xref-aff-3-1\u0022 class=\u0022xref-aff\u0022 href=\u0022#aff-3\u0022\u003E4\u003C\/a\u003E, \u003C\/li\u003E\u003Cli class=\u0022contributor\u0022 id=\u0022contrib-7\u0022\u003E\u003Cspan class=\u0022name\u0022\u003EMiguel \u00c1ngel Borge\u003C\/span\u003E\u003Cspan class=\u0022contrib-role\u0022\u003E, chief medical officer\u003C\/span\u003E\u003Ca id=\u0022xref-aff-6-1\u0022 class=\u0022xref-aff\u0022 href=\u0022#aff-6\u0022\u003E6\u003C\/a\u003E, \u003C\/li\u003E\u003Cli class=\u0022contributor\u0022 id=\u0022contrib-8\u0022\u003E\u003Cspan class=\u0022name\u0022\u003EOlga Gaspar\u003C\/span\u003E\u003Cspan class=\u0022contrib-role\u0022\u003E, nurse\u003C\/span\u003E\u003Ca id=\u0022xref-aff-1-2\u0022 class=\u0022xref-aff\u0022 href=\u0022#aff-1\u0022\u003E1\u003C\/a\u003E, \u003C\/li\u003E\u003Cli class=\u0022contributor\u0022 id=\u0022contrib-9\u0022\u003E\u003Cspan class=\u0022name\u0022\u003EFrancisco S\u00e1nchez-Rodr\u00edguez\u003C\/span\u003E\u003Cspan class=\u0022contrib-role\u0022\u003E, technician\u003C\/span\u003E\u003Ca id=\u0022xref-aff-5-1\u0022 class=\u0022xref-aff\u0022 href=\u0022#aff-5\u0022\u003E5\u003C\/a\u003E, \u003C\/li\u003E\u003Cli class=\u0022contributor\u0022 id=\u0022contrib-10\u0022\u003E\u003Cspan class=\u0022name\u0022\u003EInmaculada Aguilar\u003C\/span\u003E\u003Cspan class=\u0022contrib-role\u0022\u003E, nurse\u003C\/span\u003E\u003Ca id=\u0022xref-aff-1-3\u0022 class=\u0022xref-aff\u0022 href=\u0022#aff-1\u0022\u003E1\u003C\/a\u003E, \u003C\/li\u003E\u003Cli class=\u0022last\u0022 id=\u0022contrib-11\u0022\u003E\u003Cspan class=\u0022name\u0022\u003ERosario Jurado\u003C\/span\u003E\u003Cspan class=\u0022contrib-role\u0022\u003E, nurse\u003C\/span\u003E\u003Ca id=\u0022xref-aff-1-4\u0022 class=\u0022xref-aff\u0022 href=\u0022#aff-1\u0022\u003E1\u003C\/a\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Col class=\u0022affiliation-list\u0022\u003E\u003Cli class=\u0022aff\u0022\u003E\u003Ca id=\u0022aff-1\u0022 name=\u0022aff-1\u0022\u003E\u003C\/a\u003E\u003Caddress\u003E\u003Csup\u003E1\u003C\/sup\u003E Pain Treatment Unit, Centro de Salud \u201cDos Hermanas A\u201d (Distrito Sanitario Sevilla-Sur), 41700 Dos Hermanas, Spain\u003C\/address\u003E\u003C\/li\u003E\u003Cli class=\u0022aff\u0022\u003E\u003Ca id=\u0022aff-2\u0022 name=\u0022aff-2\u0022\u003E\u003C\/a\u003E\u003Caddress\u003E\u003Csup\u003E2\u003C\/sup\u003E Distrito Sanitario Sevilla-Sur, Alcal\u00e1 de Guadaira 41500, Spain\u003C\/address\u003E\u003C\/li\u003E\u003Cli class=\u0022aff\u0022\u003E\u003Ca id=\u0022aff-3\u0022 name=\u0022aff-3\u0022\u003E\u003C\/a\u003E\u003Caddress\u003E\u003Csup\u003E4\u003C\/sup\u003E Department of Social Psychology, Universidad de Sevilla, 41018 Sevilla, Spain,\u003C\/address\u003E\u003C\/li\u003E\u003Cli class=\u0022aff\u0022\u003E\u003Ca id=\u0022aff-4\u0022 name=\u0022aff-4\u0022\u003E\u003C\/a\u003E\u003Caddress\u003E\u003Csup\u003E3\u003C\/sup\u003E Research Support Unit, Hospital Costa del Sol, 29600 Marbella, Spain, \u003Csup\u003E4\u003C\/sup\u003E Department of Social Psychology, Universidad de Sevilla, 41018 Sevilla, Spain\u003C\/address\u003E\u003C\/li\u003E\u003Cli class=\u0022aff\u0022\u003E\u003Ca id=\u0022aff-5\u0022 name=\u0022aff-5\u0022\u003E\u003C\/a\u003E\u003Caddress\u003E\u003Csup\u003E5\u003C\/sup\u003E Servicio Andaluz de Salud, Servicio de Ordenaci\u00f3n Sanitaria, 41001 Sevilla, Spain\u003C\/address\u003E\u003C\/li\u003E\u003Cli class=\u0022aff\u0022\u003E\u003Ca id=\u0022aff-6\u0022 name=\u0022aff-6\u0022\u003E\u003C\/a\u003E\u003Caddress\u003E\u003Csup\u003E6\u003C\/sup\u003E Municipal Medical Services, 41927 Mairena del Aljarafe, Spain\u003C\/address\u003E\u003C\/li\u003E\u003Cli class=\u0022aff\u0022\u003E\u003Ca id=\u0022aff-7\u0022 name=\u0022aff-7\u0022\u003E\u003C\/a\u003E\u003Caddress\u003E\u003Csup\u003E7\u003C\/sup\u003E Pain Treatment Unit, Centro de Salud \u201cCastilleja de la Cuesta,\u201d 41950 Castilleja de la Cuesta, Spain\u003C\/address\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Col class=\u0022corresp-list\u0022\u003E\u003Cli class=\u0022corresp\u0022 id=\u0022corresp-1\u0022\u003ECorrespondence to: J Vas\u003C\/li\u003E\u003C\/ol\u003E\u003Cul class=\u0022history-list\u0022\u003E\u003Cli xmlns:hwp=\u0022http:\/\/schema.highwire.org\/Journal\u0022 class=\u0022accepted\u0022 hwp:start=\u00222004-09-07\u0022\u003E\u003Cspan class=\u0022accepted-label\u0022\u003EAccepted \u003C\/span\u003E7 September 2004\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\n\u003Ch2\u003EAbstract\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003E\u003Cstrong\u003EObjectives\u003C\/strong\u003E To analyse the efficacy of acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee, with respect to pain relief, reduction of stiffness, and increased physical function during treatment; modifications in the consumption of diclofenac during treatment; and changes in the patient\u0027s quality of life.\u003C\/p\u003E\n\u003Cp id=\u0022p-2\u0022\u003E\u003Cstrong\u003EDesign\u003C\/strong\u003E Randomised, controlled, single blind trial, with blinded evaluation and statistical analysis of results.\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003E\u003Cstrong\u003ESetting\u003C\/strong\u003E Pain management unit in a public primary care centre in southern Spain, over a period of two years.\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003E\u003Cstrong\u003EParticipants\u003C\/strong\u003E 97 outpatients presenting with osteoarthritis of the knee.\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003E\u003Cstrong\u003EInterventions\u003C\/strong\u003E Patients were randomly separated into two groups, one receiving acupuncture plus diclofenac (n = 48) and the other placebo acupuncture plus diclofenac (n = 49).\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003E\u003Cstrong\u003EMain outcome measures\u003C\/strong\u003E The clinical variables examined included intensity of pain as measured by a visual analogue scale; pain, stiffness, and physical function subscales of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index; dosage of diclofenac taken during treatment; and the profile of quality of life in the chronically ill (PQLC) instrument, evaluated before and after the treatment programme.\u003C\/p\u003E\n\u003Cp id=\u0022p-7\u0022\u003E\u003Cstrong\u003EResults\u003C\/strong\u003E 88 patients completed the trial. In the intention to treat analysis, the WOMAC index presented a greater reduction in the intervention group than in the control group (mean difference 23.9, 95% confidence interval 15.0 to 32.8) The reduction was greater in the subscale of functional activity. The same result was observed in the pain visual analogue scale, with a reduction of 26.6 (18.5 to 34.8). The PQLC results indicate that acupuncture treatment produces significant changes in physical capability (P = 0.021) and psychological functioning (P = 0.046). Three patients reported bruising after the acupuncture sessions.\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003E\u003Cstrong\u003EConclusions\u003C\/strong\u003E Acupuncture plus diclofenac is more effective than placebo acupuncture plus diclofenac for the symptomatic treatment of osteoarthritis of the knee.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022source-body\u0022\u003E\n\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\u003Ch2\u003EIntroduction\u003C\/h2\u003E\n\u003Cp id=\u0022p-9\u0022\u003EOsteoarthritis is the most common form of joint disease, and its most common location is the knee.\u003Ca id=\u0022xref-ref-1-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-1\u0022\u003E1\u003C\/a\u003E As the population ages or the disease worsens, osteoarthritis is associated with incapacity and a deteriorating quality of life owing to increased pain, loss of mobility, and the consequent loss of functional independence.\u003Ca id=\u0022xref-ref-2-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-2\u0022\u003E2\u003C\/a\u003E As a result, osteoarthritis is often treated by medical or surgical intervention. The general increase in life expectancy means that increasing numbers of people present with osteoarthritis of the knee and have a reduced quality of life. Pain relief treatment is therefore a fundamental aspect in dealing with this illness.\u003C\/p\u003E\n\u003Cp id=\u0022p-10\u0022\u003EIn patients in whom standard medical practice (pharmacological treatment) is ineffective and who are not candidates for surgery (or who reject it), other pain management procedures should be considered.\u003Ca id=\u0022xref-ref-3-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-3\u0022\u003E3\u003C\/a\u003E The role of acupuncture in osteoarthritis of the knee is still a matter of controversy, and few comparative studies of acupuncture and non-steroidal anti-inflammatory drugs (NSAIDs) for its treatment have been conducted.\u003Ca id=\u0022xref-ref-4-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-4\u0022\u003E4\u003C\/a\u003E A recent systematic review concluded that a moderate degree of evidence exists that the effect of the acupuncture treatment could be due to the placebo,\u003Ca id=\u0022xref-ref-5-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-5\u0022\u003E5\u003C\/a\u003E and further studies are therefore necessary to determine the true role of acupuncture.\u003C\/p\u003E\n\u003Cp id=\u0022p-11\u0022\u003EWe analysed the efficacy of acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee, with respect to pain relief, reduction of stiffness, and increased physical functioning during treatment; modifications in the consumption of diclofenac during treatment; and changes in patients\u0027 quality of life.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n\u003Ch2\u003EMaterials and methods\u003C\/h2\u003E\n\u003Cdiv id=\u0022sec-3\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch3\u003EStudy design and subjects\u003C\/h3\u003E\n\u003Cp id=\u0022p-12\u0022\u003EWe conducted a randomised, controlled trial with blinded evaluation and statistical analysis of results. It was carried out at the pain management unit in a public primary care centre in southern Spain, over a period of two years. The unit caters for the population of three primary care centres (75 000 inhabitants).\u003C\/p\u003E\n\u003Cp id=\u0022p-13\u0022\u003EAll the doctors at the three health centres in the study area received information about the study and inclusion criteria. We also informed them about the procedure for referring patients to the pain management unit, to be included in the selection process, and requested their collaboration in selecting patients to take part. Such patients were outpatients in whom osteoarthritis of the knee had been clinically and radiologically diagnosed according to the criteria of the American College of Rheumatology.\u003Ca id=\u0022xref-ref-6-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-6\u0022\u003E6\u003C\/a\u003E The illness had to be symptomatic at the moment of selection. All patients gave their informed consent before taking part in the study.\u003C\/p\u003E\n\u003Cp id=\u0022p-14\u0022\u003EThe pain management unit applied the following criteria for inclusion in the study: patients had to be aged 45 years or older, with pain in one or both knees for the preceding three months or longer, and with radiological evidence of osteoarthritis of the knee (at least grade 1 according to the Ahlb\u00e4ck classification,\u003Ca id=\u0022xref-ref-7-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-7\u0022\u003E7\u003C\/a\u003E \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003Etable 1\u003C\/a\u003E). They had to be outpatients and willing and able to complete the study questionnaire. Criteria for exclusion were previous treatment with acupuncture; contraindication to medication with diclofenac; inflammatory, metabolic, or neuropathic arthropathies; severe concomitant illnesses that might interfere with the clinical evaluation of the patient; severe or generalised dermopathy; pregnancy or existing treatment with antineoplasic, corticoid, or immunosuppressive drugs.\u003C\/p\u003E\n\u003Cdiv class=\u0022table pos-float\u0022 id=\u0022T1\u0022\u003E\u003Cdiv class=\u0022table\u0022\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1\u003C\/span\u003E \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003ERadiological classification of arthritis of the knee, according to Ahlb\u00e4ck\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli\u003E\u003Ca href=\u0022\/highwire\/markup\/621622\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\u0022##\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/621622\/expansion?postprocessors=highwire_figures%2Chighwire_math\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-16\u0022\u003EThe patients were divided into two groups, an intervention group treated with acupuncture plus diclofenac and a control group given placebo acupuncture plus diclofenac. We used a computer program to assign the patients randomly to one or the other group\u003Ca id=\u0022xref-ref-8-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-8\u0022\u003E8\u003C\/a\u003E; the invention group comprised 48 participants and the control group 49. We used a simple random allocation method. We sent out sealed opaque envelopes. Only the doctor applying the treatment was aware which group each patient had been assigned to, and he did not participate in any phase of the subsequent evaluation. We took precautions to maintain the confidentiality of the data concerning the participating patients. Before starting treatment, all patients observed a one week period during which they did not take any NSAIDs.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-4\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch3\u003ETreatment applied\u003C\/h3\u003E\n\u003Cdiv id=\u0022sec-5\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch4\u003EPharmacological\u003C\/h4\u003E\n\u003Cp id=\u0022p-17\u0022\u003EThe patients in both groups received a bag with 21 tablets (50 mg) of diclofenac for the week (50 mg to be taken every 8 hours) and the instruction to reduce the dose if symptoms improved. We collected and counted up the unused medication. Patients with risk factors received gastroprotective drugs.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-6\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch4\u003ETrue and placebo acupuncture\u003C\/h4\u003E\n\u003Cp id=\u0022p-18\u0022\u003EA doctor specialising in acupuncture (accredited by the Beijing University of Medical Sciences (China) and by the Scientific Society of Medical Acupuncture (ACMAS Huangdi, Spain)) selected acupuncture points on the basis of traditional treatment methods found to be effective for osteoarthritis of the knee.\u003Ca id=\u0022xref-ref-9-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-9\u0022\u003E9\u003C\/a\u003E \u003Ca id=\u0022xref-ref-10-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-10\u0022\u003E10\u003C\/a\u003E The standard acupuncture intervention entailed the insertion of sterile, single use, 30 gauge, and 45 mm length acupuncture needles into the local points GB34, SP9, EX-LE5, and ST36 (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003Efig 1\u003C\/a\u003E). The distal points were KI3, SP6, LI4, ST40. For each of the points in question the acupuncturist determined the patient\u0027s sensation of Deqi (an elicitation of needle sensation to check that the puncture was performed in the correct site). A WQ-10D1 electrostimulator was used to stimulate all the needles inserted into the local points electrically, in pairs. The treatment lasted 12 weeks, starting with visit 0 and ending with visit 11. The doctor carried out the final evaluation at visit 12, one week after the treatment had ended.\u003C\/p\u003E\n\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float odd\u0022\u003E\u003Cdiv class=\u0022fig-inline\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/www.bmj.com\/content\/bmj\/329\/7476\/1216\/F1.large.jpg?width=800\u0026amp;height=600\u0022 title=\u0022Location of selected acupuncture points\u0022 class=\u0022colorbox fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images\u0022 data-figure-caption=\u0022\u0026lt;div class=\u0026quot;highwire-markup\u0026quot;\u0026gt;\u0026lt;div class=\u0026quot;fig-caption\u0026quot; xmlns:xhtml=\u0026quot;http:\/\/www.w3.org\/1999\/xhtml\u0026quot;\u0026gt;\u0026lt;span class=\u0026quot;fig-label\u0026quot;\u0026gt;Fig 1\u0026lt;\/span\u0026gt; \u0026lt;p id=\u0026quot;p-19\u0026quot; class=\u0026quot;first-child\u0026quot;\u0026gt;Location of selected acupuncture points\u0026lt;\/p\u0026gt;\u0026lt;div class=\u0026quot;sb-div caption-clear\u0026quot;\u0026gt;\u0026lt;\/div\u0026gt;\u0026lt;\/div\u0026gt;\u0026lt;\/div\u0026gt;\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 src=\u0022http:\/\/www.bmj.com\/content\/bmj\/329\/7476\/1216\/F1.medium.gif\u0022 alt=\u0022Fig 1\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFig 1\u003C\/span\u003E \u003Cp id=\u0022p-19\u0022 class=\u0022first-child\u0022\u003ELocation of selected acupuncture points\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links list-inline\u0022\u003E\u003Cli class=\u0022download-fig first\u0022\u003E\u003Ca href=\u0022http:\/\/www.bmj.com\/content\/bmj\/329\/7476\/1216\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Fig 1\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\n\u003Cli class=\u0022new-tab\u0022\u003E\u003Ca href=\u0022http:\/\/www.bmj.com\/content\/bmj\/329\/7476\/1216\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\n\u003Cli class=\u0022download-ppt last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/621610\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\n\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-20\u0022\u003EThe same specialist carried out the placebo acupuncture, at the same frequency and for the same duration as for the group receiving the true intervention. Retractable needles went into small adhesive cylinders, such that the needle was supported but did not perforate the skin.\u003Ca id=\u0022xref-ref-11-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-11\u0022\u003E11\u003C\/a\u003E The acupuncturist then placed the needles over the same points as were used for the true acupuncture group. He connected the same pairs of electrodes and simulated the electrical connection.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-7\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch4\u003EVariables\u003C\/h4\u003E\n\u003Cp id=\u0022p-21\u0022\u003EOur general variables were patients\u0027 sociodemographic data and severity of illness (measured in duration of the osteoarthritis process in months, Ahlb\u00e4ck score, body mass index).\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-8\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch4\u003EEfficacy end points\u003C\/h4\u003E\n\u003Cp id=\u0022p-22\u0022\u003EWe used as the primary efficacy end point the WOMAC index\u003Ca id=\u0022xref-ref-12-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-12\u0022\u003E12\u003C\/a\u003E and its three subscales (pain (0-20), stiffness (0-8), and physical function (0-68)), pain in the knee on a visual analogue scale from 0 to 100, the dosage of diclofenac accumulated, and the profile of quality of life in the chronically ill (PQLC) instrument.\u003Ca id=\u0022xref-ref-13-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-13\u0022\u003E13\u003C\/a\u003E\u003C\/p\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-9\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch3\u003EStatistical analysis\u003C\/h3\u003E\n\u003Cp id=\u0022p-23\u0022\u003EWe used a freeware program\u003Ca id=\u0022xref-ref-14-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-14\u0022\u003E14\u003C\/a\u003E to calculate the sample size for a mean total WOMAC score of 20 (SD 10) for the intervention group and of 33 (SD 28) for the control group, with bilateral contrast, a significance level of 0.05, and a power of 0.80. The minimum sampling size was 69. Assuming a maximum dropout rate of 20% we increased the minimum sample size to 83 patients. We selected 97 patients (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003Efig 2\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float odd\u0022\u003E\u003Cdiv class=\u0022fig-inline\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/www.bmj.com\/content\/bmj\/329\/7476\/1216\/F2.large.jpg?width=800\u0026amp;height=600\u0022 title=\u0022Flow of participants through the trial\u0022 class=\u0022colorbox fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images\u0022 data-figure-caption=\u0022\u0026lt;div class=\u0026quot;highwire-markup\u0026quot;\u0026gt;\u0026lt;div class=\u0026quot;fig-caption\u0026quot; xmlns:xhtml=\u0026quot;http:\/\/www.w3.org\/1999\/xhtml\u0026quot;\u0026gt;\u0026lt;\/div\u0026gt;\u0026lt;\/div\u0026gt;\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 src=\u0022http:\/\/www.bmj.com\/content\/bmj\/329\/7476\/1216\/F2.medium.gif\u0022 alt=\u0022Fig 2\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFig 2\u003C\/span\u003E \u003Cp id=\u0022p-24\u0022 class=\u0022first-child\u0022\u003EFlow of participants through the trial\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links list-inline\u0022\u003E\u003Cli class=\u0022download-fig first\u0022\u003E\u003Ca href=\u0022http:\/\/www.bmj.com\/content\/bmj\/329\/7476\/1216\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Fig 2\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\n\u003Cli class=\u0022new-tab\u0022\u003E\u003Ca href=\u0022http:\/\/www.bmj.com\/content\/bmj\/329\/7476\/1216\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\n\u003Cli class=\u0022download-ppt last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/621617\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\n\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-25\u0022\u003EWe performed a baseline analysis of the two groups to seek clinically relevant differences, considering sociodemographics, severity of illness, and result. For the dropout analysis we used the Mann-Whitney U test for independent samples, together with Fisher\u0027s exact statistic (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003Etable 2\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv class=\u0022table pos-float\u0022 id=\u0022T2\u0022\u003E\u003Cdiv class=\u0022table\u0022\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2\u003C\/span\u003E \u003Cp id=\u0022p-26\u0022 class=\u0022first-child\u0022\u003EBaseline data; comparison of the randomised groups by treatment type. Values are numbers (percentages) of participants unless otherwise indicated\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli\u003E\u003Ca href=\u0022\/highwire\/markup\/621627\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\u0022##\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/621627\/expansion?postprocessors=highwire_figures%2Chighwire_math\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-27\u0022\u003EWe used SPSS, version 11.5, to analyse the results by intention to treat, on the basis of the improvement in the total WOMAC score, on the pain visual analogue scale, and the PQLC score, using Student\u0027s \u003Cem\u003Et\u003C\/em\u003E test for independent samples. We set P \u0026lt; 0.05 as the significance level for all the tests. For patients who withdrew, the score we used for each variable was the worst of the scores obtained for the intervention group and the best obtained for the control group. When a diagnosis of bilateral osteoarthritis of the knee had been made, the knee with the worse results at baseline was the knee we evaluated in the final analysis.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\n\u003Cdiv class=\u0022section\u0022 id=\u0022sec-10\u0022\u003E\n\u003Ch2\u003EResults\u003C\/h2\u003E\n\u003Cp id=\u0022p-28\u0022\u003ERecruitment took place between January 2001 and December 2002. We selected 97 patients to participate in the study, all of whom agreed to take part. \u003Ca id=\u0022xref-table-wrap-2-2\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E lists the baseline characteristics of the patients; we found no clinically relevant differences in the variables that we analysed (total WOMAC, pain visual analogue scale, PQLC) at baseline. Of the nine patients who dropped out of the study, one out of 48 (2.1%) was in the treatment group and abandoned the programme because of fear of the acupuncture process, and eight of 49 (16.3%) were in the control group (six left due to lack of improvement and two for personal reasons; \u003Ca id=\u0022xref-fig-2-2\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003Efig 2\u003C\/a\u003E). The only significant difference between completers and non-completers was their age (they were six years older than non-completers; P = 0.03). Adverse effects after acupuncture treatment were limited to three patients who reported bruising at one of the acupuncture points (SP9).\u003C\/p\u003E\n\u003Cp id=\u0022p-29\u0022\u003EIn the intention to treat analysis, the WOMAC index presented a greater, and significant, reduction in the intervention group than in the control group (mean difference 23.9, 95% confidence interval 15.0 to 32.8; the magnitude of the reduction was greater in the subscale of functional activity (17.5, 11.0 to 24.0). The same result was observed in the pain visual analogue scale (reduction 26.6, 18.5 to 34.8). A reduction of 53.9 was observed in the total accumulated number of diclofenac tablets for the intervention group compared with the control group (24.7 to 83.1). The PQLC results indicate that acupuncture treatment produces significant changes in physical capability and psychological functioning (\u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003Etable 3\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv class=\u0022table pos-float\u0022 id=\u0022T3\u0022\u003E\u003Cdiv class=\u0022table\u0022\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3\u003C\/span\u003E \u003Cp id=\u0022p-30\u0022 class=\u0022first-child\u0022\u003EBivariant analysis by intention to treat. Data are mean (SD) scores\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli\u003E\u003Ca href=\u0022\/highwire\/markup\/621632\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\u0022##\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/621632\/expansion?postprocessors=highwire_figures%2Chighwire_math\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003C\/div\u003E\n\u003Cdiv class=\u0022section\u0022 id=\u0022sec-11\u0022\u003E\n\u003Ch2\u003EDiscussion\u003C\/h2\u003E\n\u003Cdiv id=\u0022sec-12\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch3\u003EMean results\u003C\/h3\u003E\n\u003Cp id=\u0022p-32\u0022\u003EAcupuncture as a complementary therapy to pharmacological treatment of osteoarthritis of the knee is more effective than pharmacological treatment alone, in terms of reducing pain and rigidity, and improving physical functioning and health related quality of life.\u003C\/p\u003E\n\u003Cp id=\u0022p-33\u0022\u003EAccording to the criterion that an improvement in quality of life requires changes in at least two of the variables measured by the PQLC, the acupuncture provided to the intervention group was more effective than the placebo treatment in improving patients\u0027 quality of life.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-13\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch3\u003ETrue and placebo acupuncture\u003C\/h3\u003E\n\u003Cp id=\u0022p-34\u0022\u003EWe decided to use a technique in the control group that did not require transcutaneous penetration, thus avoiding neurophysiological and neurochemical responses owing to the stimulation of cutaneous receptors; the intervention and control groups received treatments that were apparently identical: real acupuncture plus medication versus placebo acupuncture plus medication. By supplying both groups with medication, we sought to overcome possible ethical objections related to the role of the control group in the study.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-14\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch3\u003EBlinding procedure\u003C\/h3\u003E\n\u003Cp id=\u0022p-35\u0022\u003EAlthough the standard treatment was given for 12 weeks, participants who dropped out of the study were mainly from the control group, and only six people were lost to the study because their condition did not improve. To reinforce the blinding of the groups we expanded the criteria for selection of study patients to include the requirement that they should not have received previous acupuncture treatment; none of the participants lost to the study made any reference to belonging to one or the other of the two groups. Both the evaluation of the results and the statistical analysis were carried out in a blind fashion. These factors reinforce our belief that the blinding procedure applied was successful.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-15\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch3\u003ELimitations of the study\u003C\/h3\u003E\n\u003Cp id=\u0022p-36\u0022\u003EObservation of the sample groups over a period of 12 weeks may be insufficient to evaluate the effects of treatment in the medium term. Moreover, we did not test the patients\u0027 awareness of belonging to one or the other group, and so their complete \u201cblindness\u201d cannot be assured. Another possible limitation was the absence of techniques to verify the behaviour of the therapist, although the time spent with each patient was recorded; this was always close to the mean value (29.4 minutes).\u003C\/p\u003E\n\u003Cp id=\u0022p-37\u0022\u003ETaking into account the duration of the study (12 weeks), we recorded patients\u0027 body mass index at the beginning and the end of the study, to evaluate the possible confounding effect of weight loss or gain. We found no significant differences.\u003C\/p\u003E\n\u003Cp id=\u0022p-38\u0022\u003EWe used different measurement techniques to evaluate the results obtained, testing whether the changes were all in the same direction and checking the consistency of the efficacy end points. We decided to use the categorical version of the WOMAC index because of the low cultural level of the population in the study area, and Spain\u0027s index of quality of life (PQLC) as a valid test for chronically ill patients. We considered the \u201ctotal accumulated consumption of diclofenac\u201d an objective variable with which to measure the responses of the two sample groups. As osteoarthritis is still an incurable illness, treatment is fundamentally aimed at improving the patient\u0027s quality of life, which is why we included this variable in the study. The consistency of the results is endorsed by the fact that the different aspects of physical functioning improved, according to both indices, the WOMAC and the PQLC. It is noteworthy that the evaluators were unaware of the group to which the patient had been assigned.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-16\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch3\u003EComparison with other studies and outlook\u003C\/h3\u003E\n\u003Cp id=\u0022p-39\u0022\u003EThe studies published to date have methodological deficiencies in the description and application of the method chosen for randomisation, the concealment of the treatment assignation scheme, the homogeneity of the groups to be compared, the control of co-interventions, the lack of control over participants\u0027 compliance with medical instructions, and the \u201cblinding\u201d of patients and evaluators; and the heterogeneity of follow up periods was high.\u003Ca id=\u0022xref-ref-15-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-15\u0022\u003E15\u003C\/a\u003E\u003Csup\u003E\u2013\u003C\/sup\u003E\u003Ca id=\u0022xref-ref-18-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-18\u0022\u003E18\u003C\/a\u003E We attempted to improve on the methodological design of previous work, using a controlled, single blind, randomised trial with evaluation and analysis by third parties; the sample size was appropriate, and we controlled for possible confounding factors to a suitable degree; the professionals involved were suitably qualified; the placebo was adequately chosen; and the quality control of the materials used was ensured. We put particular emphasis on ascertaining the patient\u0027s sensation of Deqi when acupuncture was applied, and on describing secondary effects and the success of the technique in improving the patient\u0027s quality of life (PQLC).\u003C\/p\u003E\n\u003Cp id=\u0022p-40\u0022\u003ESimilar results were found in a small, short term and long term study, carried out by using the waiting list as the control group,\u003Ca id=\u0022xref-ref-15-2\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-15\u0022\u003E15\u003C\/a\u003E and in another study that compared acupuncture plus baseline treatment with baseline treatment alone.\u003Ca id=\u0022xref-ref-16-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-16\u0022\u003E16\u003C\/a\u003E In these studies, the absence of a placebo was a serious limitation to the validity of the conclusions; a third study incorporated a placebo, but in a hospital environment considered to be of low quality,\u003Ca id=\u0022xref-ref-5-2\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-5\u0022\u003E5\u003C\/a\u003E whereas treatment was of greater intensity and duration of treatment was shorter.\u003Ca id=\u0022xref-ref-17-1\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-17\u0022\u003E17\u003C\/a\u003E Another study compared acupuncture with sham acupuncture and found no statistically significant differences.\u003Ca id=\u0022xref-ref-18-2\u0022 class=\u0022xref-bibr\u0022 href=\u0022#ref-18\u0022\u003E18\u003C\/a\u003E\u003C\/p\u003E\n\u003Cp id=\u0022p-41\u0022\u003EFuture research should extend the observation period after treatment in order to evaluate the duration of the improvement obtained and to establish treatment protocols.\u003C\/p\u003E\n\u003Cdiv class=\u0022boxed-text\u0022 id=\u0022boxed-text-1\u0022\u003E\n\u003Cdiv id=\u0022sec-17\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch4\u003EWhat is already known on this topic\u003C\/h4\u003E\n\u003Cp id=\u0022p-42\u0022\u003EAcupuncture is widely used to treat chronic pain in osteoarthritis\u003C\/p\u003E\n\u003Cp id=\u0022p-43\u0022\u003EVarious clinical trials have indicated that acupuncture may be beneficial in treating the pain that arises from osteoarthritis\u003C\/p\u003E\n\u003Cp id=\u0022p-44\u0022\u003EThe placebos used in earlier trials, based on stimulation by transcutaneous penetration, achieved an excessively high success rate, possibly owing to the neurophysiological and neurochemical responses caused by stimulation of the cutaneous receptors\u003C\/p\u003E\n\u003Cp id=\u0022p-45\u0022\u003EThe methodological quality of previous studies, in terms of randomisation, homogeneity of the groups compared, blinding, and other factors, has been put into question\u003C\/p\u003E\n\u003C\/div\u003E\n\u003Cdiv id=\u0022sec-18\u0022 class=\u0022subsection\u0022\u003E\n\u003Ch4\u003EWhat this study adds\u003C\/h4\u003E\n\u003Cp id=\u0022p-46\u0022\u003EAcupuncture, as a complementary therapy to pharmacological treatment for osteoarthritis of the knee, is more effective than pharmacological treatment alone\u003C\/p\u003E\n\u003Cp id=\u0022p-47\u0022\u003EThis manifests itself in terms of pain relief, easing stiffness, and improving physical function\u003C\/p\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section fn-group\u0022 id=\u0022fn-group-1\u0022\u003E\u003Ch2\u003EFootnotes\u003C\/h2\u003E\u003Cul\u003E\u003Cli class=\u0022fn-other\u0022 id=\u0022fn-2\u0022\u003E\n\u003Cp id=\u0022p-48\u0022\u003EWe thank M J Cano,J G de Hoyos,E Bassas, and C Andr\u00e9s for their work in the conduct of the study, and J G de Hoyos for his useful comments on the initial protocol.\u003C\/p\u003E\n\u003C\/li\u003E\u003Cli class=\u0022fn-participating-researchers\u0022 id=\u0022fn-3\u0022\u003E\n\n\u003Cp id=\u0022p-49\u0022\u003E\u003Cspan class=\u0022fn-label\u0022\u003EContributors\u003C\/span\u003E JV, CM, EP-M, and JML designed the study. EV, MAB, MDP, OG, FS-R, IA, and RJ contributed to conduct of the study and writing of the paper. Statistical analysis was done by EP-M, CM, and JML. EV revised the final version of the manuscript.\u003C\/p\u003E\u003C\/li\u003E\u003Cli class=\u0022fn-financial-disclosure\u0022 id=\u0022fn-4\u0022\u003E\n\n\u003Cp id=\u0022p-50\u0022\u003E\u003Cspan class=\u0022fn-label\u0022\u003EFunding\u003C\/span\u003E This study was partly financed by Servicio Andaluz de Salud (Grant No 192\/99). The acupuncture materials and the drugs used in the study were provided by the Sevilla-Sur health district authorities.\u003C\/p\u003E\u003C\/li\u003E\u003Cli class=\u0022fn-conflict\u0022 id=\u0022fn-5\u0022\u003E\n\n\u003Cp id=\u0022p-51\u0022\u003E\u003Cspan class=\u0022fn-label\u0022\u003ECompeting interests\u003C\/span\u003E None declared.\u003C\/p\u003E\u003C\/li\u003E\u003Cli class=\u0022fn-other\u0022 id=\u0022fn-6\u0022\u003E\n\n\u003Cp id=\u0022p-52\u0022\u003E\u003Cspan class=\u0022fn-label\u0022\u003EEthical approval\u003C\/span\u003E Valme Hospital Ethics Committee, Seville.\u003C\/p\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2\u003EReferences\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E1.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-1-1\u0022 title=\u0022View reference 1. in text\u0022 id=\u0022ref-1\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.1\u0022 data-doi=\u002210.1016\/S0140-6736(97)07226-7\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ECreamer\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EP\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EHochberg\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EMC\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EOsteoarthritis\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ELancet\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1997\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E350\u003C\/span\u003E: \u003Cspan class=\u0022cit-fpage\u0022\u003E503\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E8\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DCreamer%26rft.auinit1%253DP.%26rft.volume%253D350%26rft.issue%253D9076%26rft.spage%253D503%26rft.epage%253D508%26rft.atitle%253DOsteoarthritis.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252897%252907226-7%26rft_id%253Dinfo%253Apmid%252F9274595%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=10.1016\/S0140-6736(97)07226-7\u0026amp;link_type=DOI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref\u0022\u003E\u003Cspan\u003ECrossRef\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=9274595\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=A1997XR13500040\u0026amp;link_type=ISI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience\u0022\u003E\u003Cspan\u003EWeb of Science\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E2.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-2-1\u0022 title=\u0022View reference 2. in text\u0022 id=\u0022ref-2\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.2\u0022 data-doi=\u002210.1016\/0049-0172(90)90046-I\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EFelson\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EDT\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EThe epidemiology of knee osteoarthritis: results from the Framingham osteoarthritis study\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ESemin Arthritis Rheum\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1990\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E20\u003C\/span\u003E(\u003Cspan class=\u0022cit-supplement\u0022\u003E3 suppl 1\u003C\/span\u003E): \u003Cspan class=\u0022cit-fpage\u0022\u003E42\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E50\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DSeminars%2Bin%2Barthritis%2Band%2Brheumatism%26rft.stitle%253DSemin%2BArthritis%2BRheum%26rft.aulast%253DFelson%26rft.auinit1%253DD.%2BT.%26rft.volume%253D20%26rft.issue%253D3%2BSuppl%2B1%26rft.spage%253D42%26rft.epage%253D50%26rft.atitle%253DThe%2Bepidemiology%2Bof%2Bknee%2Bosteoarthritis%253A%2Bresults%2Bfrom%2Bthe%2BFramingham%2BOsteoarthritis%2BStudy.%26rft_id%253Dinfo%253Adoi%252F10.1016%252F0049-0172%252890%252990046-I%26rft_id%253Dinfo%253Apmid%252F2287948%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=10.1016\/0049-0172(90)90046-I\u0026amp;link_type=DOI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref\u0022\u003E\u003Cspan\u003ECrossRef\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=2287948\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=A1990EN51700005\u0026amp;link_type=ISI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience\u0022\u003E\u003Cspan\u003EWeb of Science\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E3.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-3-1\u0022 title=\u0022View reference 3. in text\u0022 id=\u0022ref-3\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.3\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EVas\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EPerea-Milla\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EE\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EMendez\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EC\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EAcupuncture and moxibustion as an adjunctive treatment for osteoarthritis of the knee-a large case series\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EAcupunct Med\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2004\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E22\u003C\/span\u003E(\u003Cspan class=\u0022cit-issue\u0022\u003E1\u003C\/span\u003E): \u003Cspan class=\u0022cit-fpage\u0022\u003E23\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E28\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DAcupuncture%2Bin%2BMedicine%26rft.stitle%253DAcupuncture%2Bin%2BMedicine%26rft.issn%253D0964-5284%26rft.aulast%253DVas%26rft.auinit1%253DJ.%26rft.volume%253D22%26rft.issue%253D1%26rft.spage%253D23%26rft.epage%253D28%26rft.atitle%253DAcupuncture%2Band%2Bmoxibustion%2Bas%2Ban%2Badjunctive%2Btreatment%2Bfor%2Bosteoarthritis%2Bof%2Bthe%2Bknee--a%2Blarge%2Bcase%2Bseries.%26rft_id%253Dinfo%253Apmid%252F15077934%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=15077934\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E4.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-4-1\u0022 title=\u0022View reference 4. in text\u0022 id=\u0022ref-4\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.4\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EPerrot\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ES\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EMenkes\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ECJ\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003ENonpharmacological approaches to pain in osteoarthritis. Available options\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EDrugs\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1996\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E52\u003C\/span\u003E(\u003Cspan class=\u0022cit-supplement\u0022\u003Esuppl 3\u003C\/span\u003E): \u003Cspan class=\u0022cit-fpage\u0022\u003E21\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E6\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E5.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-5-1\u0022 title=\u0022View reference 5. in text\u0022 id=\u0022ref-5\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.5\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EFerrandez\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EIA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EGarcia\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EOL\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EGonzalez\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EGA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EMeis Meis\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EMJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESanchez Rodriguez\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EBM\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003E[Effectiveness of acupuncture in the treatment of pain from osteoarthritis of the knee]\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EAten Primaria\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2002\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E30\u003C\/span\u003E(\u003Cspan class=\u0022cit-issue\u0022\u003E10\u003C\/span\u003E): \u003Cspan class=\u0022cit-fpage\u0022\u003E602\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E8\u003C\/span\u003E. (In Spanish.)\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DAtencion%2Bprimaria%2B%252F%2BSociedad%2BEspa%25C3%25B1ola%2Bde%2BMedicina%2Bde%2BFamilia%2By%2BComunitaria%26rft.stitle%253DAten%2BPrimaria%26rft.aulast%253DFerr%25C3%25A1ndez%2BInfante%26rft.auinit1%253DA.%26rft.volume%253D30%26rft.issue%253D10%26rft.spage%253D602%26rft.epage%253D608%26rft.atitle%253D%255BEffectiveness%2Bof%2Bacupuncture%2Bin%2Bthe%2Btreatment%2Bof%2Bpain%2Bfrom%2Bosteoarthritis%2Bof%2Bthe%2Bknee%255D%26rft_id%253Dinfo%253Apmid%252F12525334%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=12525334\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E6.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-6-1\u0022 title=\u0022View reference 6. in text\u0022 id=\u0022ref-6\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.6\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EAltman\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ER\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EAsch\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EE\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBloch\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ED\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBole\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EG\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBorenstein\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ED\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBrandt\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EK\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EDevelopment of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EArthritis Rheum\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1986\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E29\u003C\/span\u003E: \u003Cspan class=\u0022cit-fpage\u0022\u003E1039\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E49\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DArthritis%2Band%2Brheumatism%26rft.stitle%253DArthritis%2BRheum%26rft.aulast%253DAltman%26rft.auinit1%253DR.%26rft.volume%253D29%26rft.issue%253D8%26rft.spage%253D1039%26rft.epage%253D1049%26rft.atitle%253DDevelopment%2Bof%2Bcriteria%2Bfor%2Bthe%2Bclassification%2Band%2Breporting%2Bof%2Bosteoarthritis.%2BClassification%2Bof%2Bosteoarthritis%2Bof%2Bthe%2Bknee.%2BDiagnostic%2Band%2BTherapeutic%2BCriteria%2BCommittee%2Bof%2Bthe%2BAmerican%2BRheumatism%2BAssociation.%26rft_id%253Dinfo%253Apmid%252F3741515%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=3741515\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=A1986D612900016\u0026amp;link_type=ISI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience\u0022\u003E\u003Cspan\u003EWeb of Science\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E7.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-7-1\u0022 title=\u0022View reference 7. in text\u0022 id=\u0022ref-7\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.7\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EAhlb\u00e4ck\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ES\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EOsteoarthrosis of the knee. A radiographic investigation\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EActa Radiol Diagn (Stockh)\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1968\u003C\/span\u003E;(\u003Cspan class=\u0022cit-supplement\u0022\u003Esuppl 72\u003C\/span\u003E).\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E8.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-8-1\u0022 title=\u0022View reference 8. in text\u0022 id=\u0022ref-8\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-book\u0022 id=\u0022cit-329.7476.1216.8\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESilva Ayzaguer\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ELC\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-source\u0022\u003EMuestreo para la investigaci\u00f3n en ciencias de la salud\u003C\/span\u003E. \u003Cspan class=\u0022cit-publ-loc\u0022\u003EMadrid\u003C\/span\u003E: \u003Cspan class=\u0022cit-publ-name\u0022\u003EEdiciones D\u00edaz de Santos\u003C\/span\u003E; \u003Cspan class=\u0022cit-pub-date\u0022\u003E1993\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E9.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-9-1\u0022 title=\u0022View reference 9. in text\u0022 id=\u0022ref-9\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-book\u0022 id=\u0022cit-329.7476.1216.9\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ECheng\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EXN\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-source\u0022\u003EChinese acupuncture and moxibustion\u003C\/span\u003E \u003Cspan class=\u0022cit-publ-loc\u0022\u003EBeijing\u003C\/span\u003E: \u003Cspan class=\u0022cit-publ-name\u0022\u003EForeign Languages Press\u003C\/span\u003E, \u003Cspan class=\u0022cit-pub-date\u0022\u003E1987\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E10.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-10-1\u0022 title=\u0022View reference 10. in text\u0022 id=\u0022ref-10\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-book\u0022 id=\u0022cit-329.7476.1216.10\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ECobos\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ER\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EVas\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-source\u0022\u003EManual de Acupuntura y Moxibusti\u00f3n\u003C\/span\u003E. \u003Cspan class=\u0022cit-publ-loc\u0022\u003EBeijing\u003C\/span\u003E: \u003Cspan class=\u0022cit-publ-name\u0022\u003EMorning Glory\u003C\/span\u003E; \u003Cspan class=\u0022cit-pub-date\u0022\u003E2000\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E11.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-11-1\u0022 title=\u0022View reference 11. in text\u0022 id=\u0022ref-11\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.11\u0022 data-doi=\u002210.1016\/S0140-6736(97)10471-8\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EStreitberger\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EK\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EKleinhenz\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EIntroducing a placebo needle into acupuncture research\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ELancet\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1998\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E352\u003C\/span\u003E: \u003Cspan class=\u0022cit-fpage\u0022\u003E364\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E5\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DStreitberger%26rft.auinit1%253DK.%26rft.volume%253D352%26rft.issue%253D9125%26rft.spage%253D364%26rft.epage%253D365%26rft.atitle%253DIntroducing%2Ba%2Bplacebo%2Bneedle%2Binto%2Bacupuncture%2Bresearch.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252897%252910471-8%26rft_id%253Dinfo%253Apmid%252F9717924%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=10.1016\/S0140-6736(97)10471-8\u0026amp;link_type=DOI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref\u0022\u003E\u003Cspan\u003ECrossRef\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=9717924\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=000075110500012\u0026amp;link_type=ISI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience\u0022\u003E\u003Cspan\u003EWeb of Science\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E12.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-12-1\u0022 title=\u0022View reference 12. in text\u0022 id=\u0022ref-12\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.12\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBellamy\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EN\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBuchanan\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EWW\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EGoldsmith\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ECH\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ECampbell\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EStitt\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ELW\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EValidation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EJ Rheumatol\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1988\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E15\u003C\/span\u003E: \u003Cspan class=\u0022cit-fpage\u0022\u003E1833\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E40\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DThe%2BJournal%2Bof%2BRheumatology%26rft.stitle%253DThe%2BJournal%2Bof%2BRheumatology%26rft.issn%253D0315-162X%26rft.aulast%253DBellamy%26rft.auinit1%253DN.%26rft.volume%253D15%26rft.issue%253D12%26rft.spage%253D1833%26rft.epage%253D1840%26rft.atitle%253DValidation%2Bstudy%2Bof%2BWOMAC%253A%2Ba%2Bhealth%2Bstatus%2Binstrument%2Bfor%2Bmeasuring%2Bclinically%2Bimportant%2Bpatient%2Brelevant%2Boutcomes%2Bto%2Bantirheumatic%2Bdrug%2Btherapy%2Bin%2Bpatients%2Bwith%2Bosteoarthritis%2Bof%2Bthe%2Bhip%2Bor%2Bknee.%26rft_id%253Dinfo%253Apmid%252F3068365%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=3068365\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=A1988R854800020\u0026amp;link_type=ISI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience\u0022\u003E\u003Cspan\u003EWeb of Science\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E13.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-13-1\u0022 title=\u0022View reference 13. in text\u0022 id=\u0022ref-13\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-book\u0022 id=\u0022cit-329.7476.1216.13\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESiegrist\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBroer\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EJunge\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EA\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-source\u0022\u003EProfil der Lebensqualit\u00e4t Chronischkranker (PLC)\u003C\/span\u003E \u003Cspan class=\u0022cit-publ-loc\u0022\u003EG\u00f6ttingen\u003C\/span\u003E: \u003Cspan class=\u0022cit-publ-name\u0022\u003EHogrefe Verlag\u003C\/span\u003E, \u003Cspan class=\u0022cit-pub-date\u0022\u003E1996\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E14.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-14-1\u0022 title=\u0022View reference 14. in text\u0022 id=\u0022ref-14\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-book\u0022 id=\u0022cit-329.7476.1216.14\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBrown\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EBW\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-source\u0022\u003EDSTPLAN calculations for sample sizes and related problems\u003C\/span\u003E [computer program]. Version 4.2. \u003Cspan class=\u0022cit-publ-loc\u0022\u003EHouston\u003C\/span\u003E: \u003Cspan class=\u0022cit-publ-name\u0022\u003EUniversity of Texas\u003C\/span\u003E, \u003Cspan class=\u0022cit-pub-date\u0022\u003E2000\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E15.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-15-1\u0022 title=\u0022View reference 15. in text\u0022 id=\u0022ref-15\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.15\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EChristensen\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EBV\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EIuhl\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EIU\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EVilbek\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EH\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBulow\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EHH\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDreijer\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ENC\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ERasmussen\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EHF\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EAcupuncture treatment of severe knee osteoarthrosis. A long-term study\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EActa Anaesthesiol Scand\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1992\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E36\u003C\/span\u003E: \u003Cspan class=\u0022cit-fpage\u0022\u003E519\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E25\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DActa%2Banaesthesiologica%2BScandinavica%26rft.stitle%253DActa%2BAnaesthesiol%2BScand%26rft.aulast%253DChristensen%26rft.auinit1%253DB.%2BV.%26rft.volume%253D36%26rft.issue%253D6%26rft.spage%253D519%26rft.epage%253D525%26rft.atitle%253DAcupuncture%2Btreatment%2Bof%2Bsevere%2Bknee%2Bosteoarthrosis.%2BA%2Blong-term%2Bstudy.%26rft_id%253Dinfo%253Apmid%252F1514335%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=1514335\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=A1992JF15600006\u0026amp;link_type=ISI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience\u0022\u003E\u003Cspan\u003EWeb of Science\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E16.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-16-1\u0022 title=\u0022View reference 16. in text\u0022 id=\u0022ref-16\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.16\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBerman\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EBM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESingh\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EBB\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ELao\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EL\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ELangenberg\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EP\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ELi\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EH\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EHadhazy\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EV\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EA randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ERheumatology (Oxford)\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1999\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E38\u003C\/span\u003E: \u003Cspan class=\u0022cit-fpage\u0022\u003E346\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E54\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E17.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-17-1\u0022 title=\u0022View reference 17. in text\u0022 id=\u0022ref-17\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.17\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EYurtkuran\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EKocagil\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ET\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003ETENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EAm J Acupunct\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1999\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E27\u003C\/span\u003E(\u003Cspan class=\u0022cit-issue\u0022\u003E3-4\u003C\/span\u003E): \u003Cspan class=\u0022cit-fpage\u0022\u003E133\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E40\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DAmerican%2Bjournal%2Bof%2Bacupuncture%26rft.stitle%253DAm%2BJ%2BAcupunct%26rft.aulast%253DYurtkuran%26rft.auinit1%253DM.%26rft.volume%253D27%26rft.issue%253D3-4%26rft.spage%253D133%26rft.epage%253D140%26rft.atitle%253DTENS%252C%2Belectroacupuncture%2Band%2Bice%2Bmassage%253A%2Bcomparison%2Bof%2Btreatment%2Bfor%2Bosteoarthritis%2Bof%2Bthe%2Bknee.%26rft_id%253Dinfo%253Apmid%252F10729968%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=10729968\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E18.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-18-1\u0022 title=\u0022View reference 18. in text\u0022 id=\u0022ref-18\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-329.7476.1216.18\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ETakeda\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EW\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EWessel\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EAcupuncture for the treatment of pain of osteoarthritic knees\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EArthritis Care Res\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1994\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E7\u003C\/span\u003E(\u003Cspan class=\u0022cit-issue\u0022\u003E3\u003C\/span\u003E): \u003Cspan class=\u0022cit-fpage\u0022\u003E118\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E22\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DArthritis%2Bcare%2Band%2Bresearch%2B%253A%2B%2Bthe%2Bofficial%2Bjournal%2Bof%2Bthe%2BArthritis%2BHealth%2BProfessions%2BAssociation%26rft.stitle%253DArthritis%2BCare%2BRes%26rft.aulast%253DTakeda%26rft.auinit1%253DW.%26rft.volume%253D7%26rft.issue%253D3%26rft.spage%253D118%26rft.epage%253D122%26rft.atitle%253DAcupuncture%2Bfor%2Bthe%2Btreatment%2Bof%2Bpain%2Bof%2Bosteoarthritic%2Bknees.%26rft_id%253Dinfo%253Apmid%252F7727550%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=7727550\u0026amp;link_type=MED\u0026amp;atom=%2Fbmj%2F329%2F7476%2F1216.atom\u0022 class=\u0022cit-ref-sprinkles 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